More Control Than We Think – Pandemic Strategies for Healthy Eating
By Katie Bacon
As you look toward staying healthy in the new year, meaningful changes to your diet may help you manage glucose levels and maximize health in the face of COVID-19. Four experts – Whole Cities Foundation’s Dr. Akua Woolbright, low-carb guru Dr. Mariela Glandt, San Francisco General’s Dr. Rita Nguyen, and Harvard’s Dr. Lee Kaplan – shared insights for eating well, finding affordable food, and keeping your body's immune system strong.
As we’ve learned more about COVID-19, it’s become clear that the virus presents a particular threat to people who have diabetes or other metabolic conditions, including obesity. With that in mind, I spoke with a range of experts who had specific, actionable tips on how to make nutrition and lifestyle changes during the pandemic, with an eye toward improving glucose management and metabolic health – even at a time when increased stress may make that more difficult. Though their perspectives and advice differed, each expert agreed that the disruption caused by COVID is a good time to make changes. Many of their suggestions offer ways to improve health – and not just during COVID. Others offer ways to make your money stretch further at a time when many people are economically on the edge (especially in the diabetes community), yet are also looking for healthier ways to eat. Though many of us feel helpless right now, we actually have more control than we may think, and the small decisions we make about food each meal can lead to positive changes.
All of the interviews have been condensed and edited for clarity. For more nutrition information for people with diabetes, click here.
Dr. Mariela Glandt is the founder and director of the Glandt Center for Diabetes Care in Tel Aviv, Israel, which specializes in treating diabetes through very low carbohydrate diets. She is also the author of How to Eat in the Time of Covid-19.
Dr. Lee Kaplan is an internist and gastroenterologist, a leading researcher, and the director of the Weight Center at Massachusetts General Hospital.
Dr. Rita Nguyen specializes in internal medicine and has served as the Director of Chronic Disease Prevention for the San Francisco Department of Public Health, where she founded and directed the city’s Food As Medicine Collaborative. Currently, she is leading the department’s efforts to write COVID-19 guidance for all city sectors.
Dr. Akua Woolbright is the National Nutrition Program Director at the Whole Cities Foundation, an independent nonprofit foundation started by Whole Foods Market with the goal of increasing access to fresh, healthy foods and quality nutrition education.
What advice are you giving people during COVID, particularly in terms of nutrition?
Akua Woolbright: I have a mantra that I recommend: whole foods, plant based. Eat from the Earth, things that your great, great, great, great, great, great, great grandmother would have found in her outdoor environment. Another way I like to say that is food made by nature, not by people.
When I say plant-based, I don’t mean that everyone should necessarily be vegan or vegetarian, but that by building our meals around green and colorful vegetables, colorful fruit, whole grains, legumes, a few nuts, and seeds, our food starts to become micronutrient dense. We're naturally getting less of what we don't need (excess calories, saturated fat, and cholesterol) and more of what our bodies use for fuel and energy – vitamins, minerals, antioxidants, and phytonutrients.
Instead of looking at one diet for weight loss and something else for high blood pressure and then doing something else for cancer prevention and then thinking about diabetes, I try to construct a diet that will be beneficial to all of our systems, organs, cells, and DNA. Here are some of my strategies:
That mantra “whole foods, plant based” can be used as a touchstone when you’re walking through the grocery store, when you’re going to restaurants, and preparing meals in your home. Try to avoid those packaged food products.
For someone who has diabetes, lean more on the green and colorful non-starchy vegetables. Go more towards the tart fruit like berries, and avoid starchy produce.
To start, think about changing breakfast. Breakfast in America tends to be pancakes, cereals, all of that stuff. And so instead, perhaps eat some beans for breakfast. That sounds crazy to people, but we know that beans with resistant starch can help regulate blood sugar for the rest of the day. Beans are simple, they’re affordable, and you can mix them up so many different ways – pinto beans with chili powder, curried black beans – I try to get people to be creative.
Start lunch and dinner with a large salad or a vegetable soup. This will give you a lot of micronutrients and fill you up with some bulk in fiber so you're better able to manage your blood sugar and your cravings.
Drinking plenty of water is important. Some of your water can come from eating watery fruits and vegetables and drinking herbal teas. Herbal teas are great because they're high in antioxidants and vital nutrients. And by getting proper hydration, you can remove toxins from your body and curb hunger.
I try to have some urgency around the changes we need to make to lead healthier lives – we can do so much more to support our own health.
Mariela Glandt: My message is that now, more than ever, is the time to pay attention to our metabolic health. And the best way I know of to do that is to reduce how much insulin your body needs, by changing the way you eat. I argue that when you lower insulin levels, it can be possible to correct metabolic issues, like heart disease, high blood pressure, high cholesterol, obesity, and type 2 diabetes. There is a much greater chance of getting severely ill if you have a complicated metabolic condition.
So how can you improve metabolic health? By avoiding the foods that demand insulin, which are carbohydrates and sugar. For the people I work with who have type 2 diabetes, I recommend a ketogenic diet (high in fat, low in carbohydrates). Type 2 diabetes is the body telling you, “Please, don’t bring in any more sugar; I don’t have anywhere to put it.”
As far as bang for your buck, you can see many more effects from changes to diet than from exercise or other aspects of lifestyle. It’s really worth paying attention to what you put in your mouth. Here are some tips to help you:
Go as “real” as possible – the least amount of store-bought and processed food. Stick to the outer aisles of the grocery store for the fresh food. Try to make things at home. Chicken, fish, eggs, and vegetables. That in itself brings you a lot closer to health.
Drop that bowl of cereal in the morning and have two eggs instead.
I’m against snacking. I think we should eat enough fat and protein to feel full without snacking. Aiming to eat no more than three meals a day can help to decrease insulin levels throughout the day.
Eat dinner as early as possible, because humans are not meant to be eating during the night time. That one change of eating earlier can be really helpful in terms of reducing insulin levels.
Rita Nguyen: The people I typically see are at our county hospital, so they tend to be economically and socially disadvantaged. Now, with the economic stress brought on by COVID-19, more people are facing similar economic situations to my patients. When you have plenty of money and access to food, it's much, much easier to comply with dietary recommendations for diabetes. In the setting of restricted resources, I tell my patients that portion control becomes more important because you're not able to always pick the healthier items, and oftentimes you may be only able to purchase or access shelf-stable foods.
For people facing financial constraints, here’s what I suggest:
You may end up eating more carbs to keep yourself full, but you should be particularly mindful to seek out complex carbs rather than simple carbs, and whole grains whenever you can (although some of the nicer whole grains are more expensive).
Try to cook from scratch as much as possible.
Protein is meant to keep people full longer and has less of an effect on your blood sugar.
People can do these things anytime, but these strategies become even more important when you're facing real limitations in what you can purchase.
The final piece of advice I give is to quit smoking. The leading cause of death among people with diabetes is heart disease, and smoking contributes greatly to heart disease. Plus, cigarettes are expensive. If you smoke a pack a day, that costs over $2,000 a year. I totally understand that increases in smoking and drinking happen when there's increased economic stress. But for some people, if you point out the economic and health costs, it can help them quit.
Lee Kaplan: Because we're all eating at home to a much greater extent during COVID, we have the opportunity to learn how to cook and eat less processed foods than we did previously. This disruption provides a good time to make long-term lifestyle changes – whether it’s reducing stress or getting better sleep or eating healthier food. That’s the silver lining of all this. You can build new patterns with a keen eye toward where you eat, when you eat, how you eat, and what you eat, which all become part of a healthier dietary lifestyle.
To decrease the risk of developing diabetes, other metabolic diseases, cancer, and heart and vascular disease, you want to eat the diets that have been shown to improve specific risks [read about the American Diabetes Association’s dietary guidelines for diabetes here] – for instance, you want to follow diets that have iron, Omega-3s and Omega-6s, and are low in saturated fats, have no trans fats, and are low in concentrated carbohydrates. But none of those recommendations, in my view, has been demonstrated to cause substantial or durable weight loss. So, you should follow these diets for their health benefits, not because they will necessarily cause weight loss.
To the greatest degree possible during this time, you should also:
- Decrease stress.
- Have physical activity in your life.
- Get healthy sleep.
- Normalize your body’s internal rhythms through regular patterns of eating and sleeping, and accommodating third shift work or travel as needed.
Do you have specific recommendations around trying to boost the immune system during COVID?
Akua Woolbright: I like to make sure that we're getting a variety of colorful produce at every meal. Every color corresponds to a different set of nutrients that feed different parts of the body. By eating a variety of colorful produce – purple foods, red, orange, yellow, green, brown, white – you are feeding different systems and organs, and really drilling down into your cells with nourishment and the ability to heal and rejuvenate the body.
When we're looking for immunity, the three colors that stand out are orange, yellow, and green foods. This includes things like citrus, yellow or orange peppers, squashes, even some sweet potatoes, dark green leafy vegetables, broccoli, and cabbage. They're all effective in strengthening immunity, and those green foods give an added boost by removing toxins from the body.
I also like to talk about high-quality protein and making sure that people with diabetes and those who are trying to build a healthy immune system are careful to get enough protein throughout the day. Aim for at least 10 grams of protein, up to 20, spread throughout the day at breakfast, lunch, and dinner. Why is protein so important for blood sugar and maybe even weight loss? It helps to stabilize cravings and blood sugar and makes you feel more even and balanced, allowing you to make active choices.
The quality of protein throughout the day is also important because our immune antibodies are made from protein. So we're looking at lean meat: salmon is particularly great for immune boosting. When I'm looking for a plant-based protein powder, I'm looking for something clean, made with few ingredients, and with the protein coming from hemp, brown rice, or green peas.
With the pandemic economy, many people have even less ability than they did before to buy certain foods. How do you talk to people about healthy food choices at a time when so many are so economically stretched?
Rita Nguyen: Right now, it’s all about connecting people to resources through things like food pantries and food pharmacies, because you can only go so far with advice.
Healthcare can't ignore the fact that you have to address food insecurity. You can't assume that the person sitting in front of you has been employed the last nine months and has enough to eat. For people with diabetes facing food insecurity, if you maintain the dose of insulin or other medications, you either risk hypoglycemia because they're not eating consistently, or maybe you’re under-treating them because their eating habits have changed. So for any diabetes healthcare professional, I think screening for food insecurity should be part of the standard of care at least during the pandemic.
Mariela Glandt: It’s a matter of prioritizing and looking for the sales. You can get meats that are on sale. Eggs also provide a huge amount of nutrition, they’re amazing, and they’re much cheaper than meat.
Akua Woolbright: I kind of treat this like church, where I give you all of the Ten Commandments, all the dos and don'ts. But then I tell people, "You're going to start where you are and do what you can. If you can only go buy the fresh produce or dried beans, do that. If you can buy one new item, figure out which one you like and start there."
Some of the recommendations I help people think through are logistical. If there's one person in your neighborhood or your family who has a car, maybe you come together and drive further out to a grocery store that's more affordable. Maybe you find hardy produce on sale, like cabbage, carrots, or squash, that will last for two to four weeks. Or look for fresh produce on sale. You purchase it and freeze it for later.
I talk to people about being creative in how you use frozen foods and canned and dried beans to stretch what you have so you can go to the grocery store less frequently. In the face of the coronavirus, we don't want to be out in the grocery store every day anyway.
I eat very simply, and that’s how I encourage others to eat too. I make this wonderful curried chickpea dish with canned chickpeas. It’s a little bit of curry powder, turmeric, salt, garlic in the skillet with some oil. Add the chickpeas, stir them all up until they start turning yellow from the curry and the turmeric and then let them just simmer for a minute. Then I top that with whatever greens I have, and then maybe some chunks of tomato. I put that on top of some brown rice, and I am happy. And chickpeas are inexpensive.
Any other tips you are giving your patients now, specifically in terms of COVID?
Lee Kaplan: COVID is creating all kinds of stress, including a lot of economic stress for people. Be aware of that and pay attention. Stress is a huge negative factor in all the health conditions we're talking about, whether it is obesity, diabetes, or liver disease. I think it's very important to try to find new ways of relieving the stress, if possible. Whether through walks, time for solitude, or whatever activities help you relax.
Mariela Glandt: The virus is going to go around. It matters where it lands. It matters if it lands on fertile soil or not; I think that how metabolically healthy you are plays a really big role here. So in this regard, we have more control than we think. I’m not saying we have all the control, definitely not, but at a time when we can feel helpless, there’s a lot we can do to try to be healthy – and we can start by deciding what to eat.
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